成本和質量關系的探討成本和質量的聯合評價是否能改變丹麥醫(yī)院的排名？【外文翻譯】

1、外文文獻翻譯譯文一、外文原文原文：原文：Explingtherelationshipbetweencostsquality:DoesthejointevaluationofcostsqualityaltertherankingofDanishhospitaldepartmentsAbstractObjectiveThepurposeistoevaluatetherelationshipbetweencostsqualitytoasses

2、swhetherthejointevaluationofcostsqualityaffectstherankingofhospitaldepartmentsrelativetocomparisonbasedoncostsalone.MethodsUsingpatientleveldataf3754patientsinsixvulardepartmentsweestimatefixedeffectmodelsfcosts(linear)q

3、uality(logistic).Weconsidertwoqualitymeasuresmtalitywoundcomplications.Toassesswhetherthejointevaluationofcostsqualityaffectstherankingofdepartmentsweconstructjointconfidenceregionsfeachpairofdepartmentaleffectsfcostsqua

4、lityusingabootstrapmethodrankdepartmentsaccdingtotheircosteffectivenessratio.ThefindingsareusedtoevaluateatheyofaUshapedcostqualityrelationship.ResultsTheassociationbetweencostqualitydiffersdependingonhowqualityismeasure

5、d.Lowercostsareassociatedwithhighermtalityimplyingacostqualitytradeoff.Incontrastthereisnoclearassociationbetweencostswoundcomplicationsamongvulardepartments.ConclusionsComparedtobenchmarkingofdepartmentsbasedsolelyonthe

6、ircostsweshowthattherankingofdepartmentsmaybealteredconsiderablywhenqualityistakenintoaccount.Consequentlyitisimptanttohaveawellroundedviewofdepartmentalobjectiveswhenundertakingperfmanceevaluation.Theresultsfmtalitymayc

7、ausality’problemi.e.thatqualitymayalsoaffectcosts.Inthecurrentstudyweavoidthisproblemsinceweproposeamethodofanalyzecostsqualityseparately.OtheralternativesarediscussedinHauckStreetinthemegeneralcaseofhavingmultipleobject

8、ives(amongwhichefficiencyqualityaretwo).Theydiscussthreealternativessuchas:analysesoftheobjectivesinisolationcalculationofanindexinwhichthedifferentobjectivesareweightedsomehowtheuseofmultivariatemodelsaccountingfcrelati

9、onamongobjectives.Thisstudyseekstoprovidenewevidenceonthecostqualityrelationshipinhospitaldepartments.Weprovideatheeticalframewkfdiscussingtherelationshipbetweencostsqualitythatalsounderpinstheidentificationproblem.Wepro

10、poseaseparateanalysisofcostsqualitytherebyavoidingthecausalidentificationproblem.Weaccountfpotentialcrelationbetweencostsqualitywhenconductinginferenceontheirrelationshipusingabootstrapprocedure.Alsoweaddresstheissueofmu

11、ltiplecriteriausingcosteffectivenessasarankingdevice.PreviousstudieshavesuggestedthatspecialtylevelanalysisispreferabletohospitallevelanalysisTheadvantagewhenanalyzeapartmentsinsteadofhospitalsisthatitismelikelythatthere

12、isgreaterHomogeicinthetypesofpatientstreatedaswellasgreaterstardizationintheproductionprocessClearlythedrawbackisthatthereareasmallernumberofcomparatssuchasinthepresentstudywhereweoperatewithsixvulardepartmentsonly.Thisi

13、saninherentdrawbackinmanycontextssuchassmallercountrieswherealargernumberofhospitalssimplycannotberealized.Toovercomethisanearlierstudyhasdemonstratedthatinferencesamongasmallnumberofganizationscanbeimprovedbyexploitingp

14、atientleveldata.InthepresentstudywehaveaccesstothesamepatientlevelcostdataasinOlsenStreet.Theydemonstratedthatitwaspossibletoidentifythosedepartmentsthatwerestatisticallysignificantlymetechnicallyefficientthanothers.Inth

15、epresentstudyweextendthisanalysisbyexplingwhateffecttheincpationofqualityhasontheefficiencyofthevariousdepartments.Thepaperisganizedasfollows.Firstwediscusswhatqualitymeasurestoapplyinefficiencyanalysesprovideananalytica